Bhilwara model: How this Rajasthan district brought Covid-19 under control

By March 23, as cases continued to rise, the police department swung into action erecting barricades within the district and at its borders to further clamp down on intra and inter district movement
Three days before the Modi government announced a nationwide lockdown on March 24, Rajendra Bhatt, the district collector of Bhilwara in Rajasthan was gearing up for a precarious situation. On March 21, he issued the first directions in the district closing down all industries, factories, brick kilns and other establishments in which more than 10 workers were employed. Bhatt hadn’t acted promptly though. The Rajasthan government had directed all district collectors on March 19 to impose Section 144 in their respective districts after a couple who had returned from Italy were found infected with Coronavirus in Jaipur. That was when the first case was reported in Bhilwara as well.

Despite the slow start, the following days would witness a containment strategy executed with clockwork precision, immaculate coordination and extreme efficiency under Bhatt’s watch - a strategy that would make Bhilwara the first district in the country to stop new infections within a span of less than two weeks. With a peak of 27 cases on March 31, the district hasn’t seen a new infection till date.

Industrial lockdown of textile hub

One of the first moves while medical interventions were being made was to get people off the streets. With many large industries involved in textile manufacturing, the order to shut down industries quite literally put the lid on all industrial activity and employment in Bhilwara. Realising the repercussions on the economy and law and order due to the ban on large industries, the district administration swung into action the very next day ordering the district industrial incharge to talk with all establishments urging them not to entrench workers and ensure a part of their wages were paid. 

“I spoke to industry associations and contacted individual enterprises on phone asking them to retain their staff. We issued special passes to factory owners so that they could process wage payments to workers” said Vipul Jani, the industry incharge of Bhilwara. All public transport including state buses, autorickshaws, commercial carriages and taxis were banned. The same day, the administration asked all hotels to reserve atleast five rooms for use by district medical personnel. Resorts were asked to provide 20 rooms to district officials to meet impending medical emergencies.

By the evening of March 21, there was a sense of desperation seeping into the administration after the realisation that almost half of the 20 odd cases in Rajasthan were in Bhilwara. What further set the cat among the pigeons was that a doctor who had returned from Saudi Arabia tested positive along with five other medical staff who had worked in close proximity to him. The possibility of infections to patients who were handled by them at the local Brijesh Bangar Memorial Hospital where they worked was infinite. By the latter half of March 22, orders had been issued to local officials to draw route charts for every zone in the district and ensure essential supplies for households and fertiliser and other essential farm inputs for farmers. These were to be distributed in each of these zones according to plan.

Hotels, hostels taken over for quarantine

By March 23, as cases continued to rise, the police department swung into action erecting barricades within the district and at its borders to further clamp down on intra and inter district movement. The administration meanwhile ordered that all police checkposts be supplied with furniture, tents and drinking water to ensure perpetual manning by police personnel. With the district and various zones within it effectively sealed, the administration requisitioned for quarantine facilities with atleast 6,000 beds in various places. The guest houses of various big industries were put at the disposal of health authorities and the district administration instructed officials to draw a list of various dharamshalas (charitable guest houses) whose rooms could be requisitioned to increase quarantine capacity. Additionally, hostels of government and privately owned educational institutions were readied to house patients. After the order, 11 educational institutions gave hundreds of hostel rooms to the administration. “We knew patients would become violent and alienated if quarantine facilities weren’t good. We had 6038 rooms, to be precise, at our disposal in various hotels and hostels in which patients could be quarantined with their own personal toilets. We provided them food prepared by the Akshaya Patra Foundation which prepared healthy and nutritious food. Even now we have 1,500 to 2,000 rooms on call if need be even though there have been no new cases in our district”, said Rajesh Suvalka, assistant collector of Bhilwara who was given the charge of acquiring quarantine facilities during the crisis. 

On the same day, instructions were issued to ensure that cow sheds got fodder on time and all vehicles carrying fodder for cows were allowed to cross various checkposts. Local officials were also asked to get in touch with social workers, philanthropists and industrialists who wanted to fund food and supply of other essentials to those leading ‘a hand to mouth existence', truck drivers, street vendors and daily wage workers. “We helped the administration in any way we could. In Bhilwara we sent trucks with 10 tonnes of wheat flour. Similar consignments have been sent to other parts of the state and country” said Rakesh Mishra, a local employee of the Indian Tobacco Company (ITC) coordinating supply of essential items.

Screening 92 per cent of the population

While the district administration was building the infrastructure to meet the consequences of community transmission, medical teams were already in the final stages of tracing down the first batch of suspected infections and all those who were in their proximity. “There were ICU patients apart from medical staff who had tested positive initially. We took hospital records and sent teams to the villages of these patients and then tracked down all people they had been in touch with. We quarantined more than 6000 people across the district – either at their own homes or at available facilities” said a medical officer at the district hospital in Bhilwara.

By March 25, the administration was getting more concerned about the situation at Brijesh Bangar Memorial Hospital in Bhilwara which seemed to be the epicenter of the spread across the district. Of the 19 cases reported by now, an overwhelming majority were medical professionals; many of whom worked at this hospital. There were 63 patients in the Intensive Care Unit (ICU) of the hospital; some of whom would later test positive for coronavirus. The hospital’s records were seized and teams sent to track the families of all 63 patients in villages across the district. Their families were subject to coronavirus tests and areas surrounding their homes sprayed with disinfectants. All patients were immediately ordered to be tested. The hospital staff were tested and sent off to quarantine facilities. The number of tests at the government owned Mahatma Gandhi hospital was increased from 200 to 300 a day and all patients from the private hospital were moved there the next day. Orders were issued to local officials to find people in villages who had been previously admitted in the private hospital’s ICU and get them screened for coronavirus. Officials were asked to immediately rush in 50 additional doctors and 100 nurses to tackle the situation. A 24-hour war room was created in the collector’s office which would be manned by three teams working in eight hour shifts every day. They were tasked with monitoring every aspect of tracing, testing, quarantine and lockdown in the district.

‘Corona fighters’ to monitor quarantined suspects

By March 26, more than 6000 people had been tested and were either asked to self-quarantine or admitted to the nearest facility. The district administration then took the unprecedented step of taking control of five private hospitals along with their staff and medical equipment. All inpatient admissions at Brijesh Bangar Memorial Hospital were also moved into quarantine facilities in Bhilwara. By March 28, the administration got the results of the first door-to-door survey and medical screening commissioned on March 21. The list contained names and addresses of all symptomatic people displaying signs of cough, fever, cold and breathing problems. 

With this list in hand, a second survey and screening exercise of all those identified in the first list along with their family members was ordered. This exercise would be coordinated in every village by panchayat heads, block development officers and block level medical officers. The screening exercise of the first list suspects and their family members was completed within 24 hours. By March 29, when the second list was handed to the administration, almost 2000 teams had reportedly screened 2.2 million people – 92 per cent of the district’s entire population. 

The same day, special ‘Corona Fights’ teams were formed in every village that included Accredited Social Health Activists (ASHA), anganwaadi workers and other local officials. These teams ensured that people who were asked to self-quarantine did not venture out of their homes. These teams constantly monitored quarantined families and sent daily reports on their health and isolation status to district authorities. To ensure that people didn’t face shortages of masks and hand sanitisers, the administration asked the police to track and crack down on any signs of black marketing. Strict instructions were issued to check sale of these essential medical products above the maximum retail price. By March 30, the number of infected cases touched 27 in Bhilwara – the last time a new case was reportedly recorded in the district. 

District authorities maintain that no new cases have been recorded till date. On April 3, the administration decided to sanction a third survey and screening of people who had been left out of the previous two rounds. This was to test workers who had returned to their villages in Bhilwara from outside the state after their establishments and workplaces shut down following the nation wide lockdown. Restrictions were further tightened with even media persons not allowed to go out and report. Rajendra Bhatt, district collector of Bhilwara told a wire agency after tightening the screws, “The people have cooperated with the administration till now. I would request them to keep up the cooperation for another 10 days and not step out of their homes. The administration has complete rights to punish anyone who violates the lockdown order.” At the same time almost 3,900 ‘helpless and homeless people’ in urban and rural areas were identified and provided shelter and food.  

With no new Coronavirus cases till date, the ‘Bhilwara model’ has become a talking point in policy circles on how ruthless isolation and door-to-door screening can help stem the spread of the deadly pandemic. For a district that was being projected as ‘India’s Italy’ by the British Broadcasting Corporation (BBC), the method in the madness to control a dangerous situation seemed to have saved the day and countless lives.  

 


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